Tags

Type your tag names separated by a space and hit enter

Heart failure with normal left ventricular ejection fraction: what is the evidence?

Abstract

Heart failure with a normal ejection fraction (HFNEF) is a common clinical problem with many unsolved questions regarding pathophysiology, diagnosis, and therapy. Although the term diastolic heart failure has been abandoned, diastolic left ventricular (LV) dysfunction together with combined systolic ventricular and arterial stiffening are considered to be the main pathophysiologic mechanisms in HFNEF. Current guidelines define HFNEF by symptoms or signs of heart failure in the presence of LV ejection fraction of more than 50%, but with additional evidence of LV diastolic dysfunction. Definite diagnosis of HFNEF requires exclusion of valvular heart disease, constrictive pericarditis, and several noncardiac diseases. Echocardiographic assessment of the tissue Doppler-derived filling index E/E', which is the ratio of the peak early mitral valve flow velocity to the peak early diastolic mitral annular velocity, should improve the noninvasive estimation of filling pressures in suspected HFNEF. Elevated plasma levels of natriuretic peptides may confirm HFNEF if tissue Doppler echocardiography is inconclusive. Treatment of HFNEF is symptom oriented and mainly based on pathophysiologic assumptions such as heart rate reduction, blood pressure control, and maintenance of sinus rhythm. In contrast to heart failure with reduced ejection fraction, large-scale randomized controlled drug trials for HFNEF are scarce and could not demonstrate mortality reduction so far.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. michael.kindermann@t-online.de

    , , ,

    Source

    Trends in cardiovascular medicine 18:8 2008 Nov pg 280-92

    MeSH

    Adrenergic beta-Antagonists
    Angiotensin II Type 1 Receptor Blockers
    Angiotensin-Converting Enzyme Inhibitors
    Calcium Channel Blockers
    Clinical Trials as Topic
    Diastole
    Digitalis Glycosides
    Drug Therapy, Combination
    Evidence-Based Medicine
    Heart Failure
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Practice Guidelines as Topic
    Randomized Controlled Trials as Topic
    Stroke Volume
    Treatment Outcome
    Ventricular Dysfunction, Left

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    19345315

    Citation

    Kindermann, Michael, et al. "Heart Failure With Normal Left Ventricular Ejection Fraction: what Is the Evidence?" Trends in Cardiovascular Medicine, vol. 18, no. 8, 2008, pp. 280-92.
    Kindermann M, Reil JC, Pieske B, et al. Heart failure with normal left ventricular ejection fraction: what is the evidence? Trends Cardiovasc Med. 2008;18(8):280-92.
    Kindermann, M., Reil, J. C., Pieske, B., van Veldhuisen, D. J., & Böhm, M. (2008). Heart failure with normal left ventricular ejection fraction: what is the evidence? Trends in Cardiovascular Medicine, 18(8), pp. 280-92. doi:10.1016/j.tcm.2008.12.003.
    Kindermann M, et al. Heart Failure With Normal Left Ventricular Ejection Fraction: what Is the Evidence. Trends Cardiovasc Med. 2008;18(8):280-92. PubMed PMID: 19345315.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Heart failure with normal left ventricular ejection fraction: what is the evidence? AU - Kindermann,Michael, AU - Reil,Jan-Christian, AU - Pieske,Burkert, AU - van Veldhuisen,Dirk J, AU - Böhm,Michael, PY - 2008/10/30/received PY - 2008/12/13/revised PY - 2008/12/17/accepted PY - 2009/4/7/entrez PY - 2009/4/7/pubmed PY - 2009/5/8/medline SP - 280 EP - 92 JF - Trends in cardiovascular medicine JO - Trends Cardiovasc. Med. VL - 18 IS - 8 N2 - Heart failure with a normal ejection fraction (HFNEF) is a common clinical problem with many unsolved questions regarding pathophysiology, diagnosis, and therapy. Although the term diastolic heart failure has been abandoned, diastolic left ventricular (LV) dysfunction together with combined systolic ventricular and arterial stiffening are considered to be the main pathophysiologic mechanisms in HFNEF. Current guidelines define HFNEF by symptoms or signs of heart failure in the presence of LV ejection fraction of more than 50%, but with additional evidence of LV diastolic dysfunction. Definite diagnosis of HFNEF requires exclusion of valvular heart disease, constrictive pericarditis, and several noncardiac diseases. Echocardiographic assessment of the tissue Doppler-derived filling index E/E', which is the ratio of the peak early mitral valve flow velocity to the peak early diastolic mitral annular velocity, should improve the noninvasive estimation of filling pressures in suspected HFNEF. Elevated plasma levels of natriuretic peptides may confirm HFNEF if tissue Doppler echocardiography is inconclusive. Treatment of HFNEF is symptom oriented and mainly based on pathophysiologic assumptions such as heart rate reduction, blood pressure control, and maintenance of sinus rhythm. In contrast to heart failure with reduced ejection fraction, large-scale randomized controlled drug trials for HFNEF are scarce and could not demonstrate mortality reduction so far. SN - 1873-2615 UR - https://www.unboundmedicine.com/medline/citation/19345315/Heart_failure_with_normal_left_ventricular_ejection_fraction:_what_is_the_evidence L2 - https://linkinghub.elsevier.com/retrieve/pii/S1050-1738(08)00141-2 DB - PRIME DP - Unbound Medicine ER -